HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: SCANNED Permit Number: M a-003_7
St. Lucie County FICEVED
Building Permit Application DEC 031010
Planning and Development5ervices
Building and Code Regulation Division Permitting Department
2300 VirginioAvenue, Fort Pierce FL 34982 St. Luce County
Phone:(772)462-1553 Fax:(772)462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line II
Address:
Description:
Property Tax ID #:
Site Plan Name: i
Project Name:
Setbacks Front
S6 c16F ,5W 'i
502-DOCO-
Back:
ReptaC ZXis-hRnS 611
bCa�iav� o b r D rrf k,
L IHVAC L
❑ Electric C
Total Sq. Ft of Construc
Cost of Construction: $
Gas Tank
Plumbing
Piping
10
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Ivy (!U dL�l UJG I l�/%(4 LCW 4ck No.
Left
acid delft. (In Sari
ML e)kretC Ra me
Shutters Q'Windows/Doors
Generator Roof = Roof pitch
tion: it S Ft. of First Floor. _
_f Utilities: _SewerSeptic
City: t Dr+ f �eru V State: "FL
Zip Code: 3 C(qL49 Fax:
Phone No._ T%o2 g9>53
E-Mail:_O(?Gl} f i S pir (j MCu 1Ligef F�Gy7llic'.C�>Y(
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: I
Company:
Building Height:
City: V LV 12 t P O C n State;—F—L
Zip Code: 39 9 6 o Fax:
Phone No. _M-5(nr7-r7S00
E-Mail:CI('B Wt�CQ.LLrjIQl7-G6nSli idG'%k) ('O
State or County License: (`k_-15Z5836
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
�SI�PELEMENTALCONSTRUCTI�N<LIE �Lq� I1�k
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DESIGNER/ENGINEER: Not Applicable
Name:
FbRIV1ATION � � art`�G t�"`' * s �' �� , iE � a.�;
u 1} 6�r14..4 m(<i�t� � „`. .: ' R i t1�!R
MQRTGAGECOMPANY: ,2�_Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:_
FEE SIMPLE TITLE HOLD ER: Not Applicable
Name:
BONDING COMPANY:
Name:
X NotApplicable
Address:
Address:
City:
City:
Zip: Phone.
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby madeto obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced priorto the issuance of a permit.
St. Lucie County snakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review. room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your`property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Nntire of rnmmenrPMPnt
Y
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Co ra o er
STATE OF FLORIDA
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STATE OF FLORIDA
COUNTY OF
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COUNTY OF �/l,"
The fo oing in wa acknq�vied a efore me
thi , day of A .20 by
The forgoin&InstruJ�}ent was acknowledged before me
this 20/ "by
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Name of pens makingstatement
Name of persopp makingstateirnt
Personally Known OR
Produced Identification
Personally Known,/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced --
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(Signature of N
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(Signature of Notary P{t61ic-State o
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ateof Fi "da
Commission No. s° DoCommission
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BARBARA
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REVIEWS
FRONT
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
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_7
DATE
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COMPLETED
'�3/
Rev.812117
of Florida
239276
in 9.2019